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Adult Protective Services The Process: From Intake to Adult Abuse Registry February 2015
Adult Protective Services
The Process:From Intake to Adult Abuse Registry
February 2015
Title 33 Chapter 69: Reports of Abuse, Neglect and
Exploitation of Vulnerable Adults
Adult Protective Services (“APS”) is charged with theresponsibility of investigating allegations of abuse,neglect or exploitation of vulnerable adults.
With the consent of the vulnerable adult or his/herrepresentative, APS assists with arranging for theprotection of vulnerable adults whose health andwelfare may be adversely affected through abuse,neglect, or exploitation.
33 V.S.A. §6901, §6907
Title 33 Chapter 69
DEFINITIONS
Vulnerable Adult
• Any person 18 years of age or older who:
– Is a resident of a facility required to be licensedunder Chapter 71 of Title 33;
– Is a resident of a psychiatric hospital or apsychiatric unit of a hospital;
– Has been receiving personal care services formore than 1 month from a home health agency orfrom a person or organization that offers,provides, or arranges for personal care;
Vulnerable Adult
• Any person 18 years of age or older whoregardless of residence or whether any type ofservice is received, is impaired due to braindamage, infirmities of aging, or physical,mental, or developmental disability:– That results in some impairment of the
individual’s ability to provide for his/her own carewithout assistance—food, shelter, clothing,healthcare, supervision, or management offinances.
Vulnerable Adult
• Any person 18 years of age or older who, dueto brain damage, infirmities of aging, or aphysical, mental, or developmental disabilityhas an impaired ability to protecthimself/herself from abuse, neglect orexploitation.
33 V.S.A. §6902 (14)
Caregiver
• A person, agency, facility or other organizationwith responsibility for providing subsistence ormedical or other care to a vulnerable adult, whohas assumed responsibility voluntarily, bycontract or by an order of court;
• A person providing medical care, custodial care,personal care, mental health services,rehabilitative services or any other kind of careprovided as required because of another’s age ordisability.
33 V.S.A. §6902 (2)
Abuse
• Any treatment of a vulnerable adult whichplaces life, health, or welfare in jeopardy orwhich is likely to result in impairment ofhealth.
• Any conduct committed with an intent orreckless disregard that such conduct is likely tocause unnecessary harm, unnecessary pain, orunnecessary suffering to a vulnerable adult.
Abuse
• Unnecessary or unlawful confinement orunnecessary or unlawful restraint of a vulnerableadult;
• Any sexual activity with a vulnerable adult by acaregiver from a caregiving facility or program(other than consensual relationship);
• Intentionally subjecting a vulnerable adult tobehavior which should reasonably be expected toresult in intimidation, fear, humiliation,degradation, agitation, disorientation, or otherforms of serious emotional distress;
Abuse
• Administration, or threatened administration,of a drug, substance, or preparation to avulnerable adult for other than a legitimatepurpose and lawful, medical or therapeutictreatment.
33 V.S.A. §6902(1)
Exploitation
• Willfully using, withholding, transferring, ordisposing of funds or property of a vulnerableadult without or in excess of legal authority forthe wrongful profit or advantage of another;
• Acquiring possession or control of or an interestin funds or property of a vulnerable adult throughthe use of undue influence, harassment, duress,or fraud;
• The act of forcing or compelling a vulnerableadult against his or her will to perform servicesfor the profit or advantage of another;
Exploitation
• Any sexual activity with a vulnerable adult whenthe vulnerable adult does not consent or whenthe actor knows or should know that thevulnerable adult is incapable of resisting ordeclining consent to the sexual activity due to ageor disability or due to fear of retribution orhardship, whether or not the actor has actualknowledge of vulnerable status.
33 V.S.A. §6902 (6)
Neglect
• Purposeful or reckless failure or omission by acaregiver to provide care or arrange for goodsor services necessary to maintain the healthor safety of a vulnerable adult—food, clothing,medicine, shelter, supervision and medicalservices—unless the caregiver is actingpursuant to the wishes of the vulnerable adultor his/her representative, or terminal caredocument.
Neglect
• Purposeful or reckless failure or omission by acaregiver to make a reasonable effort, inaccordance with the authority granted thecaregiver, to protect a vulnerable adult fromabuse, neglect, or exploitation by others.
Neglect
• Purposeful or reckless failure or omission by acaregiver to carry out a plan of care for avulnerable adult when such failure results inor could reasonably be expected to result inphysical or psychological harm or a substantialrisk of death to the vulnerable adult, unlessthe caregiver is acting pursuant to the wishesof the vulnerable adult or his or herrepresentative, or a terminal care document.
Neglect
• Purposeful or reckless failure or omission by acaregiver to report significant changes in thehealth status of a vulnerable adult to aphysician, nurse, or immediate supervisor,when the caregiver is employed by anorganization that offers, provides or arrangesfor personal care.
• May be repeated conduct or a single incident
33 V.S.A. §6902 (7)
Protective Services
• Services, action, or intervention that will, through voluntaryagreement or court action, prevent further neglect, abuse, orexploitation of vulnerable adults– 33 V.S.A. §6902 (9)
• Examples:– Assist with securing orders of protection/relief from abuse orders– Provide referrals to law enforcement and appropriate agencies– Assist with securing representative payee– Assist with reversing fraudulent credit card charges– Assist with securing appropriate supervision, guidance and/or
counseling– Assist with petition for appointment of guardian– Assist securing safe and sanitary living conditions.
Substantiated Report
• Determination by the Commissioner or herdesignee that an investigative report is basedupon accurate and reliable information thatwould lead a reasonable person to believethat the vulnerable adult has been abused,neglected or exploited.
33 V.S.A. §6902 (12)
APS INTAKE PROCESS
• Report submitted to Adult Protective Services intake worker by fax,phone or secure, web-based report.
• Intake worker screens report to determine if allegations meet oneor more statutory definitions of abuse, neglect and/or exploitation,and if the alleged victim meets statutory definition of “vulnerableadult.”
• Intake worker screens out reports when alleged victim does notmeet statutory definition of abuse, neglect or exploitation.
• Intakes are completed and a determination made regardingopening a case for investigation, or closing a report, within 48 hoursof receipt of the report, if no additional information is required tocomplete the intake.
Adult Protective Services Policies and Procedures
APS INTAKE PROCESS
• If initial report is complete upon receipt, the report isassigned to an investigator.
• If initial report is not complete, intake staff will make 2documented attempts to reach the reporter by phone, andmake a determination regarding opening a case forinvestigation or closing the report within 4 business days ofreceipt of the initial report.
• Notify reporter, victim or victim’s representative if thereport is not opened, and if referrals were made to anotheragency.
Adult Protective Services Policies and Procedures
Initial Reports
• Name, address and contact information for reporter,vulnerable adult, accused, caregiver and guardian, ifapplicable.
• Age of vulnerable adult• Nature of vulnerable adult’s disability• Nature and extent of alleged abuse, neglect and/or
exploitation• Any evidence of previous abuse, neglect and/or
exploitation• Additional information regarding cause of injuries and
other relevant information known by reporter33 V.S.A. §6904
Why is an investigation not opened following an initial reportalleging abuse, neglect or exploitation?
• Incident previously investigated, or currently under investigation(same vulnerable adult, same alleged perpetrator, sameallegations).
• Alleged vulnerable adult does not meet statutory definition ofvulnerable adult.
• Allegations do not meet statutory definition of abuse, neglect orexploitation.
• Reports incomplete as received, and 2 attempts to reach thereporter were unsuccessful.
• Report concerns self-neglecting adult.• Report is a resident-to-resident or patient-to-patient incident within
a licensed setting, exceptions set forth in APS Policies andProcedures (e.g., incident alleges sexual abuse/assault that wasresident-to-resident; incident required medical treatment for oneor more residents involved in incident).
FY 2014 Snapshot
• In SFY14, APS assigned 1,515 investigations forinvestigation. The number of investigations assigned is488 more than the previous year, which is an increaseof 48%.
• In SFY14, APS completed 1,366 investigations. Thenumber of investigations completed is 427 more thanthe previous year, which is an increase of 45%.
• In SFY14, APS recommended 165 substantiations. Thenumber of substantiations is 24 more than theprevious year, which is a 17% increase. Two of thesubstantiations were made automatically withoutinvestigation as a result of a criminal conviction.
FY 2014 Snapshot
• In SFY14, APS recommended substantiations in12% of the cases they completed investigations.This is a 20% decrease from the SFY13recommended substantiation rate of 15%.
• In SFY14, the average daily caseload for APSInvestigators was 30. This is a 25% increase fromthe SFY13 average daily caseload of 24.
• In SFY14, the average daily open cases for APSwas 335. This is a 42% increase in the SFY13average daily open cases of 236.
Reporters• Confidential
– Unless reporter consents to disclosure– Unless a judicial proceeding results from the report
• Concerned citizen• Mandated*:
– AHS employees, contractors, grantees involved in caregiving– Medical professionals– School employees and contractors– Mental health professionals– Social workers– Personal care providers; caregivers– Law enforcement– Employees of Adult Day, AAA, Senior Centers, Meal Programs– Employees and owners of nursing homes, hospitals, residential care homes, home health
agencies, therapeutic care homes, group homes, developmental homes, intermediate carefacility
*Administrative penalties ($500 - $5,000) may be assessed for failure of mandated reporter toreport.
33 V.S.A. §6903, §6913(b)
Investigations
• Intake commences an investigation into the reportwithin 48 hours
• Keep reporter and alleged victim informed at all stagesof investigation
• Notify reporter, victim and victim’s representative ofthe outcome of an investigation
• Notify the perpetrator and perpetrator’s representativeof the outcome of an investigation.
33 V.S.A. §6906 (a), (c); Adult Protective Services Policiesand Procedures
Investigation Requirements
• Visit to alleged victim’s residence and locationof alleged abuse, neglect or exploitation
• Interview witnesses and other collateralcontacts
• Interview reporter
• Interview alleged victim if he/she consents
• Offer accused interview
33 V.S.A. §6906 (b)
Investigative Reports
• Describe all evidence obtained duringinvestigation
• Recommend finding of substantiated orunsubstantiated
33 V.S.A. §6906
**Reports are reviewed and approved byinvestigator’s supervisor.
Disclosure of Information
• Investigative reports, absent a court order, only disclosedto:– Commissioner or her designee– Adult Protective Services investigator– Accused– Vulnerable adult or his/her representative– Office of Professional Regulation by direction of the
Commissioner– Law enforcement– State’s attorney/Office of Attorney General
• Criminal investigation/prosecution• Civil investigation/enforcement action
33 V.S.A. §6911(a)(1)
Disclosure of Information
• Relevant information obtained through investigation,absent a court order, only disclosed:– Secretary of AHS or his designee for purposes of:
• Remediating or preventing abuse, neglect, or exploitation
• To assist the agency in its monitoring and oversight responsibilities
– In the course of a relief from abuse proceeding,guardianship proceeding, or any other court proceedingwhen:
• The Commissioner deems it necessary to protect the victim and
• The victim or his/her representative consents to disclosure.
33 V.S.A. §6911 (a)(2)
Disclosure of Information
• Limited to “minimum amount necessary” toaccomplish intended purpose:
– Investigative Reports
– Relevant information
33 V.S.A. 6911(a)(1) and (2)
Recommendation for Substantiation
• Report is based upon accurate and reliable information thatwould lead a reasonable person to believe that thevulnerable adult has been abused, neglected or exploited.
• Notify accused of right to appeal--To commissioner--To Human Services Board
• If accused does not request Commissioner’s hearing within15 days of notification of recommendation ofsubstantiation, Commissioner makes finding ofsubstantiation and notifies accused of right to appeal toHuman Services Board.
33 V.S.A. §, 6902 (12), §6906 (c)
Unsubstantiated Reports
• DAIL retains records as a confidential recordfor 6 years
• If no court proceeding is brought, or theHuman Services Board reverses asubstantiation, after 6 years, records shall bedestroyed following notice to accused.
33 V.S.A. §6906 (e)
Human Services Board Appeal
• Within 30 days of notification from APS ofsubstantiation by the Commissioner, theaccused may file an appeal before the HumanServices Board. 33 V.S.A. 6906(d).
• Standard of proof: preponderance of theevidence
Adult Abuse Registry
• If an appeal is filed, the name of the accused“shall not” be added to the Adult AbuseRegistry until the substantiation is final.
• If no appeal is filed, the perpetrator’s name isplaced on the Adult Abuse Registry followingthe substantiation by the Commissioner.
33 V.S.A. §6906
Adult Abuse Registry
• Information included in Registry:
– Name of individual substantiated for abuse,neglect, or exploitation of a vulnerable adult.
– The date the name was placed on the registry.
– The nature of the finding: abuse, neglect orexploitation of a vulnerable adult.
33 V.S.A. §6911 (b)
Disclosure of Information from AdultAbuse Registry: LIMITED
• State’s Attorney or Attorney General• Public in accordance with Nursing Home Reform Act of
1986 and relevant regulations• Employer (providing care, custody, treatment,
transportation, or supervision of children or vulnerableadults); requires release
• Agencies assisting with employer functions, homesharing, personal care services, developmentalservices, or mental health services for vulnerableadults; requires release
• Commissioner of DCF or designee for licensing orregistration of facilities regulated by DCF
Disclosure of Information from AdultAbuse Registry: LIMITED
• Commissioner of Health or designee foroversight and monitoring persons served by orcompensated with funds from Department ofHealth
• Upon request when relevant to other states’APS offices.
33 V.S.A. §6911(c)(1)-(7)
Expungement from Adult AbuseRegistry
• Expungement may be requested at any time bythe individual listed.
• Expungement requests are directed to the DAILCommissioner.
• Petitioner has burden of showing whyexpungement should be granted.
33 V.S.A. §6911(f)
Penalties for Abuse, Neglect orExploitation
• Financial: administrative penalty up to $10,000• Notification to Office of Professional Regulation• Substantiation for:
– Sexual abuse– Sexual exploitation– Exploitation in an amount in excess of $500– Abuse which causes grievous injury to or death of
vulnerable adult– Neglect which causes grievous injury to or death of
vulnerable adult33 V.S.A. §69139(a)
